As the US debates and reforms its insurance-based healthcare system yet again, it鈥檚 important to remember that this is the only advanced democracy that fails to provide cover to all of its citizens.
The promise to 鈥渞epeal and replace鈥� the framework brought in by the (ACA), also known as Obamacare, was a key part of Donald Trump鈥檚 presidential campaign. On Monday, the Republican-controlled US Congress introduced a bill called the in an effort to keep that promise.
Observers are still scrambling to analyse and 鈥渟core鈥� the proposal to help the US people understand what changes it will unleash and at what cost. But its broad significance is crystal clear: the new bill will dismantle much of the ACA. To understand what this means you need to comprehend the law it aims to undo 鈥� signed by President Obama in March 2010.
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Obamacare improved access
According to and others at the Urban Institute, the non-partisan think tank in Washington DC where I work, the ACA has accomplished a lot. It to an estimated 20 million extra people and reduced the uninsured rate among nonelderly adults by about 40 per cent.
It improved access to care. It eliminated discrimination by health status in several insurance markets. Both the government costs associated with the ACA and total national health expenditures have run below original estimates. And contrary to many predictions, rates of employer-sponsored insurance coverage remain high, while the ACA has had no adverse effects on overall employment.
Republicans claim the ACA is in a death spiral 鈥� a scenario in which premiums rapidly rise as enrolment drops. That is untrue. Some areas of the country have seen , but mostly because of upward adjustment by insurers that had priced their plans too low originally; these premiums are not high in absolute terms.
Poor alternative
of the Republican ACA alternative do not bode well for the health and well-being of US citizens. Most experts agree that it will reduce health insurance coverage and increase household costs; the only questions are , for whom and by how much.
The bill eliminates the mandate requiring most US citizens to have insurance, a centrepiece of the ACA and a key provision for in insurance markets. Just as crucially, it undermines Medicaid, an important national safety net providing more than 70 million low-income Americans (many of them children, elderly or people with disabilities) with insurance and other critical benefits.
As Andy Slavitt, former administrator of the Centers for Medicare and Medicaid Services, , the bill is 鈥渂asically a tax cut ($600 billion) funded by gutting Medicaid鈥�.
Emergency care scrapped
Incredibly, an ACA requirement that health insurance plans cover such as emergency care, maternity and newborn services, prescription drugs, and mental health and addiction treatment .
For decades, US citizens have been and have had higher rates of disease and injury than people living in other wealthy nations. This 鈥渉ealth disadvantage鈥� affects young and old, men and women, rich and poor. Last year, our life expectancy dropped for the first time since 1993.
Many factors are contributing to this, and how we organise and deliver healthcare is one of them. does not guarantee good health for a nation, but it is a critical ingredient. Many Americans may lose this too if the Republican Party鈥檚 ACA 鈥渞eplacement鈥� passes.
The result will be a giant step backwards for the nation鈥檚 health and well-being.
